Purepath Healing Services LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PUREPATH HEALING SERVICES LLC

Practice address

202 Jean Ave N
Lake Elmo, MN 55042-5516

Phone

(612) 456-2069

NPI assigned

Nov 20, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Luqman Ibrahim

Title

Owner

Phone

(612) 456-2069

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1732060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732060800000",
    "number": "1457176729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 JEAN AVE N",
            "city": "LAKE ELMO",
            "state": "MN",
            "postal_code": "550425516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 JEAN AVE N",
            "city": "LAKE ELMO",
            "state": "MN",
            "postal_code": "550425516",
            "telephone_number": "612-456-2069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUREPATH HEALING SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-20",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A",
        "authorized_official_last_name": "IBRAHIM",
        "authorized_official_first_name": "LUQMAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-456-2069"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Lake Elmo, MN
• Providers in Lake Elmo, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.